Mikyung Yun OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-009764 Issued in IL

Legal business name

MIKYUNG YUN OD PC

Practice address

150 Smith Rd
St Charles, IL 60174-5203

Phone

(630) 513-9566

Fax

(630) 513-9786

NPI assigned

Mar 3, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mikyung Baker

Title

President

Phone

(630) 606-1618

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1801119987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SMITH RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SMITH RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745203",
            "telephone_number": "630-513-9566",
            "fax_number": "630-513-9786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKYUNG YUN OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-03",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MIKYUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-606-1618"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046-009764",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in St Charles, IL
• Providers in St Charles, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.